Hanna comes from Mekelle, in theTigray region of Ethiopia. At one point in her life she suffered a traumatic experience that led to depression:
I have always been happy and healthy in my life. Until something terrible happened to me: my only child died. After that dramatic episode, my life hasn’t been the same. I kept thinking about him, and couldn’t sleep at night. I felt so sad and would be so nervous and my heart would beat very fast. This made me so worried I thought something bad was going to happen to me as well.
The case of Hanna is not unusual and many other Ethiopians have similar stories. In Ethiopia, it is estimated that 15% of people are affected by major mental illness or substance abuse disorders.
Past challenges have been the lack of mental health specialists outside the capital, Addis Ababa, and the poor quality of services provided for mental, neurological and substance use disorders. In addition, people suffering from mental illness are often the most marginalized, and affected by stigma and discrimination.
Strong government commitment for mental health care
The Government of Ethiopia has shown strong commitment for improving mental health care and getting services to the people who need them, as evidenced not only by the development of a mental health strategy, but also by the allocation of new funds for the roll-out of a mental health strategy across the country. Since a pilot project in 2010-2013, the Government has been increasing the budget for mental health for scaling up mental health services for training, supervision and procurement of psychotropic medications.
“There has been a consistent political commitment by policy makers, because they understood that Ethiopia was on an accelerated economic and social development path and the country was developing at 10% growth annually. Such a rapid economic growth requires a physically and mentally healthy population in order to maintain and sustain the achievement of this economic and social development” says Dr Tedla Wolde-Giorgis, Mental Health Advisor in the Office of the Minister of the Ethiopian Federal Ministry of Health.
According to Dr Kesetebirhan Admasu, Minister of Health, the five principles that contributed to the successful scaling up of mental health services include: “country ownership, community ownership, going for a significant scaling for impact, and integration of mental health services into existing health systems.”
Building partnerships
The Federal Ministry of Health has also worked hard to build Partnerships. It has also been working closely with the World Health Organization, the European Union and Foundation d’Harcourt (a Geneva-based non-profit foundation which promotes international projects and partnerships in the fields of mental health, psychosocial support and social development) to successfully implement the Mental Health Gap Action Programme (mhGAP), a WHO programme which serves as a guide to countries, particularly low- and middle-income countries, in scaling up services for mental, neurological and substance use disorders. The Ethiopian mental health programme was built in line with WHO recommendations for integrating hospital-based and community-based services.
“The broad vision has been to integrate mental health in the existing primary health-care system by leveraging the existing health delivery platforms. The strategy that we developed emphasizes the training of health staff on mental health issues using the mhGAP programme and making sure that they are provided with close supervision and oversight at the different health centres. To this end, the mhGAP training materials and approach was very helpful to us” says Dr Tedla Wolde-Giorgis.
Training based on mhGAP
Following adaptation of the mhGAP materials to the Ethiopian context, training began. In 2010-2013, in the four pilot regions of Amhara, Oromia, Tigry and Southern Nations, Nationalities and People (SHHPR), more than 200 non-specialized health workers were trained, in 19 heath facilities.
Further government investment following the pilot phase has enabled almost 300 more health workers to be trained, with 158 health-care facilities now providing care for mental health. Many people, who would otherwise have had no access to care, have been supported.
In the case of Hanna, she was lucky enough to visit a primary health centre where the nurse who saw her had gone through an mhGAP Base Course training. “When I visited the clinic the nurse asked me many questions and she finally explained to me that all my symptoms were due to what they call depression. She explained that many mothers who lose a child experience it and listened to me. She told me that I do not need medications. With time, I have felt much better and my sleep has become regular again.”